GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 2007

H                                                                                                                                                    1

HOUSE BILL 1904

Short Title:     Diabetes Self-Mgmt/Reimbursement.		(Public)
Sponsors:	Representatives Allen, Cotham, Bryant, England (Primary Sponsors);  Carney, Faison, Farmer‑Butterfield, Fisher, and Harrison.
Referred to:	Health, if favorable, Appropriations.

May 1, 2007

A BILL TO BE ENTITLED

AN ACT PERTAINING TO MEDICAID REIMBURSEMENT FOR DIABETES OUTPATIENT SELF‑MANAGEMENT EDUCATION PROGRAMS.

Whereas, effective November 1, 1999, North Carolina Medicaid began covering Diabetes Outpatient Self-Management Training; and

Whereas, Diabetes Outpatient Self‑Management Training programs provide patient education in the successful management of diabetes; and

Whereas, Diabetes Outpatient Self‑Management Training programs provide education about self‑monitoring of blood glucose, diet, and exercise, including developed insulin treatment plans for insulin-dependent patients and motivation for patients to use the skills for self‑management; and

Whereas, Article XVII of the  Social Security Act allows coverage and payment only for those services that are considered to be medically reasonable and necessary; and

Whereas, North Carolina Medicaid will only reimburse providers for Diabetes Outpatient Self-Management Training provided "incident" to a physician's professional services; and

Whereas, Diabetes Self-Management Education is reimbursed as part of the Medicare Part B programs as overseen by the Centers of Medicare and Medicaid Services (CMS) provided the entity has received recognition from the American Diabetes Association; and

Whereas, there are 80 recognized American Diabetes Association Diabetes Education Programs in North Carolina; and

Whereas, there are over 720,000 North Carolinians who have been diagnosed with diabetes, including many Medicaid recipients; and

Whereas, diabetes education can improve the health and welfare of North Carolina Medicaid recipients and reduce overall costs to the State Medical Assistance Plan; Now, therefore,

The General Assembly of North Carolina enacts:

SECTION 1.  The Department of Health and Human Services, Division of Medical Assistance, shall reimburse entities for providing a Diabetes Outpatient Self‑Management Education Program regardless of whether the entity provides the program incident to a physician's professional services.  Reimbursement shall be made only if the entity:

(1)       Meets the National Standards for Diabetes Self‑Management Education Programs;

(2)       Has been recognized by the American Diabetes Association for meeting the National Standards for Diabetes Self-Management Education;

(3)       Has obtained a "Certificate of Recognition" from the American Diabetes Association which is maintained by the provider and made available to DMA or its agent upon request; and

(4)       Has received documentation certifying the need for diabetic training and documentation of the training provided.

Any pharmacy or pharmacist providing diabetes education services for Medicaid enrollees shall obtain relevant patient history information and provide a summary of specific problems discussed to the Medicaid enrollee's primary care physician.  The summary required by this section shall be prepared or reviewed by the pharmacist who provided the educational services.  This section shall not be interpreted to permit a pharmacist to provide services otherwise requiring a Clinical Pharmacist Practitioner from the Pharmacy Board.

SECTION 2.  This act becomes effective July 1, 2007.